No single issue has preoccupied the Surgeons General of the past
four decades more than smoking. The reports of the Surgeon
General have alerted the nation to the health risk of smoking,
and have transformed the issue from one of individual and
consumer choice, to one of epidemiology, public health, and risk
for smokers and non-smokers alike.

Debate over the hazards and benefits of smoking has divided
physicians, scientists, governments, smokers, and non-smokers
since Tobacco nicotiana was first imported to Europe from its
native soil in the Americas in the sixteenth century. A dramatic
increase in cigarette smoking in the United States in the
twentieth century called forth anti-smoking movements.
Reformers, hygienists, and public health officials argued that
smoking brought about general malaise, physiological
malfunction, and a decline in mental and physical efficiency.
Evidence of the ill effects of smoking accumulated during the
1930s, 1940s, and 1950s. Epidemiologists used statistics and
large-scale, long-term, case-control surveys to link the
increase in lung cancer mortality to smoking. Pathologists and
laboratory scientists confirmed the statistical relationship of
smoking to lung cancer as well as to other serious diseases,
such as bronchitis, emphysema, and coronary heart disease.
Smoking, these studies suggested, and not air pollution,
asbestos contamination, or radioactive materials, was the chief
cause of the epidemic rise of lung cancer in the twentieth
century.
On June 12, 1957, Surgeon General Leroy E. Burney
declared it the official position of the U.S. Public Health
Service that the evidence pointed to a causal relationship
between smoking and
lung cancer.

The impulse for an official report on smoking and health,
however, came from an alliance of prominent private health
organizations. In June 1961, the American Cancer Society, the
American Heart Association, the National Tuberculosis
Association, and the American Public Health Association
addressed a letter to President John F. Kennedy, in which they
called for a national commission on smoking, dedicated to
"seeking a solution to this health problem that would interfere
least with the freedom of industry or the happiness of
individuals." The Kennedy administration responded the following
year, after prompting from a widely circulated critical study on
cigarette smoking by the Royal College of Physicians of London.
On June 7, 1962, recently appointed Surgeon General Luther L.
Terry announced that he would convene a committee of experts to
conduct a comprehensive review of the scientific literature on
the smoking question. Terry invited representatives of the four
voluntary medical organizations who had first proposed the
commission, as well as the Food and Drug Administration, the
Federal Trade Commission, the American Medical Association, and
the Tobacco Institute (the lobbying arm of the tobacco industry)
to nominate commission members. Ten were finally chosen,
representing a wide swath of disciplines in medicine, surgery,
pharmacology, and statistics, though none in psychology or the
social sciences. Candidates qualified only if they had taken no
previous stand on tobacco use.

Meeting at the National Library of Medicine on the campus
of the National Institutes of Health in Bethesda, Maryland, from
November 1962 through January 1964, the committee reviewed more
than 7,000 scientific articles with the help of over 150
consultants. Terry issued the commission's report on January 11,
1964, choosing a Saturday to minimize the effect on the stock
market and to maximize coverage in the Sunday papers. As Terry
remembered the event, two decades later, the report "hit the
country like a bombshell. It was front page news and a lead
story on every radio and television station in the United States
and many abroad."

The report highlighted the deleterious health consequences
of tobacco use. Smoking and Health: Report of the Advisory
Committee to the Surgeon General held cigarette smoking
responsible for a 70 percent increase in the mortality rate of
smokers over non-smokers. The report estimated that average
smokers had a nine- to ten-fold risk of developing lung cancer
compared to non-smokers: heavy smokers had at least a
twenty-fold risk. The risk rose with the duration of smoking and
diminished with the cessation of smoking. The report also named
smoking as the most important cause of chronic bronchitis and
pointed to a correlation between smoking and emphysema, and
smoking and coronary heart disease. It noted that smoking during
pregnancy reduced the average weight of newborns. On one issue
the committee hedged: nicotine addiction. It insisted that the
"tobacco habit should be characterized as an habituation rather
than an addiction," in part because the addictive properties of
nicotine were not yet fully understood, in part because of
differences over the meaning of addiction.

The 1964 report on smoking and health had an impact on
public attitudes and policy. A Gallup Survey conducted in 1958
found that only 44 percent of Americans believed smoking caused
cancer, while 78 percent believed so by 1968. In the course of a
decade, it had become common knowledge that smoking damaged
health, and mounting evidence of health risks gave Terry's 1964
report public resonance. Yet, while the report proclaimed that
"cigarette smoking is a health hazard of sufficient importance
in the United States to warrant appropriate remedial action," it
remained silent on concrete remedies. That challenge fell to
politicians. In 1965, Congress required all cigarette packages
distributed in the United States to carry a health warning, and
since 1970 this warning is made in the name of the Surgeon
General. In 1969, cigarette advertising on television and radio
was banned, effective September 1970.